Domhnall MacAuley: Primary care and the President

July 11, 2008

Everyone is an expert in primary care. Newsagents, bar staff, waiters, hairdressers and little old ladies laden with shopping all have their own view. In the anonymity of a city you can tune in, unrecognised, to everyday conversations. Public opinion seems to be changing with GPs seen as overpaid, underworked, and not performing. The news is not good.

But, you would not have known this from the mood at the Society of Academic Primary Care conference. Perhaps because of its multidisciplinary make up, so that primary care is no longer synonymous with general practice, or, may because academia is protected from market forces of public opinion, the conference seemed oblivious to this turning tide.

Tom Fahy, the introductory keynote speaker, made evidence based clinical practice seem blindingly obvious. No drama, no rhetoric, no emotive arguments. The essence of clarity. But, that’s a true expert. His move to Dublin sees him face different challenges in a world that still retains the values of old style doctor centred general practice.

As UK general practice is systematically dismantled, the semi private and somewhat archaic Irish model becomes increasingly attractive. Tom, ahead of the game, as always.

Scott Murray lead the palliative care interest group on Thursday morning. Even the SAPC is embracing the US early morning breakfast meeting model of croissant flavoured conversation. As the number one BMJ Making a Difference topic, I was particularly interested.

This was followed by a keynote by Anne Rogers on the expert patient. She introduced some new concepts like the “flat-pack” patient where everything neatly fits together– and the “surveillance society” where testing is all important.

This neatly fitted with Paul Glasziou who asked how often we should test cholesterol to evaluate change bearing in mind biological variability and measurement error- after about three years.

On a lighter note, when a mobile phone rang during an important talk by an elegant and respected speaker, we all mentally tut tutted. But, could only smile when the phone was traced to her own handbag left with her colleagues 10 rows back.

As the shop window for primary care research in these islands, this meeting was a little disappointing. Many were preliminary, incomplete studies or work in progress, the themes felt tired with few really new ideas. I struggled to see the relevance of many of the presentations to real patients.

The strongest message came from Mary Robinson, former President of Ireland and Human Rights Commissioner at the UN. The daughter of two GPs, she challenged us all to think of human rights and social responsibility. And, she said, her early grounding in the importance of human rights was in seeing how her father cared for his patients young and old. A timely reminder.

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